A small study of 20 primary care doctors found that most felt unprepared to advise patients about medical cannabis, despite receiving frequent questions from patients of all ages. Only 10% had any training specific to older adults, a population facing heightened risks from cannabis use including falls, drug interactions, and cognitive effects. The findings underscore a growing gap between patient demand and physician readiness.

Cannabis use among older adults has increased sharply over the past decade, and patients of all ages are increasingly turning to their primary care physicians for guidance on therapeutic use. Yet medical education has not kept pace with this demand. When physicians lack confidence and training in cannabis counseling, patients are left to rely on dispensary staff, anecdotal information, or trial and error, all of which carry real clinical risk, particularly for older adults managing multiple medications and chronic conditions.

This study, published as a research letter in the Journal of the American Geriatrics Society, examined how primary care physicians perceive their own preparedness to discuss cannabis with patients of different ages. Using a mixed-methods design that combined a structured survey with brief qualitative interviews, the researchers recruited a convenience sample of 20 physicians from five clinics within a single academic health system in San Diego, California. The rationale for the study was straightforward: cannabis legalization has expanded access, patient inquiries are rising, and older adults represent a growing user population with distinct physiological vulnerabilities, including heightened fall risk, polypharmacy exposure, and susceptibility to cognitive effects.

All 20 physicians reported that patients of both younger and older age groups ask about cannabis for medical purposes. Yet approximately half (45 to 50%) disagreed that they felt competent to provide such advice, and only 10% had ever received cannabis education specifically focused on older adults. In qualitative interviews, physicians perceived age-specific risks: falls, drug interactions, and cognitive decline for older adults versus dependency and high-THC product misuse for younger adults. Most adopted informal harm-reduction strategies such as recommending low starting doses and oral or topical formulations. The authors acknowledge the study’s primary limitations: the very small, geographically homogeneous convenience sample precludes any generalization, and the abbreviated research letter format limits methodological transparency. They call for larger, more representative studies and the development of age-specific cannabis counseling guidelines.

This study captures something I see every day in practice: physicians who are genuinely concerned about their patients’ cannabis use but feel they have almost no training to guide them. The fact that only 10% of these doctors had received any education on cannabis specific to older adults is striking but not surprising. Medical schools and residency programs have been painfully slow to integrate cannabinoid medicine into their curricula, and most physicians are left to piece together guidance from scattered literature and personal experience. What this study gets right is naming the gap. What it cannot do, given its very small sample from one California institution, is tell us how widespread or how deep that gap really is.

In my own practice, I see the consequences of this training deficit regularly. Older patients arrive having already started cannabis products, often at doses or in formulations that are not ideal for their clinical picture. What I do in those situations is meet them where they are: review every medication for interaction risk, discuss product selection carefully, and start with the lowest effective dose, typically favoring CBD-predominant formulations and avoiding inhaled routes when respiratory or fall risk is present. This kind of deliberate, individualized counseling is exactly what most primary care practices lack the infrastructure to provide, and this study underscores why that needs to change.

This study sits at the very beginning of the research arc on physician preparedness for cannabis counseling, particularly for older adults. It is hypothesis-generating rather than hypothesis-testing. Its value lies not in its statistical power, which is minimal, but in its qualitative texture: the firsthand accounts of physicians describing how they improvise strategies in the absence of guidelines. For clinicians, these findings serve as a mirror rather than a map. They confirm what many practitioners already suspect about their own training gaps but do not yet offer a validated pathway to close them.

From a pharmacological and safety standpoint, the age-specific concerns raised by the interviewed physicians are well grounded. Older adults metabolize cannabinoids differently, face higher baseline fall risk, and commonly take medications (anticoagulants, sedatives, antihypertensives) that can interact with both THC and CBD through cytochrome P450 pathways. The informal harm-reduction strategies these physicians described, such as recommending low starting doses and avoiding inhaled products, align with general prudence but lack the specificity that evidence-based guidelines could provide. Clinicians seeing older patients who use or are considering cannabis should, at minimum, perform a thorough medication reconciliation, screen for fall risk, and document the conversation. That single step of structured documentation helps ensure continuity and accountability in a space where clinical guidance remains notably sparse.